18th Apr 2018
Treating Post-Op Carpal Tunnel Patients with Physical Therapy
Unfortunately, for some of our carpal tunnel patients, surgical intervention may be needed to decrease chronic pain and restore function. While carpal tunnel surgery may improve long term outcomes for these patients, after surgery, patients will experience swelling, stiffness and weakness. At this time, physical therapy rehabilitation will help patients heal more quickly and increase the likelihood of achieving pain-free optimal function in day to day activities. Particularly for patients who had severe damage prior to surgery or when surgery is indicated for both hands, post-surgical rehabilitation greatly increases the success of surgical intervention.
The 3 Phases of Treatment for Post-Surgical Carpal Tunnel Patients
Post-surgical rehabilitation for carpal tunnel patients involves three phases. Throughout each phase, specific physical therapy tools and modalities can be strategically utilized to help speed these patient’s recovery and completion of therapeutic goals.
Before creating a comprehensive rehabilitation plan, it’s important to establish a baseline of hand, finger and grip strength as part of an initial evaluation. Carpal tunnel can lead to a weakness in the wrist and hand. It is hoped that surgical repair can stop this weakening, but a rehab regimen focused on increasing hand and grip strength is needed to help restore this strength. The Jamar 3-Piece Hand Evaluation Set is a great choice for practitioners to establish a baseline of strength and use throughout the rehabilitation process to track progress and adjust treatment as necessary.
The Jamar 3-Piece set includes:
- Hand dynamometerto establish hand strength
- Pinch gauge to measure pinch strength
- Finger goniometer to evaluate the strength of the individual digits
*both digital and analog models are available depending upon your preference and/or requirements.
* Jamar+ Digital Hand 3 Piece Evaluation Kit and Jamar Hydraulic Hand Evaluation Kit
After surgery, patients will experience local edema and swelling. This can be addressed with lymphatic massage and Game Ready’s cold compression therapy for the upper extremity. Cold compression is an advanced treatment that uses cold therapy, well-known for its analgesic properties, combined with compression, which can immediately decrease local swelling.
In addition, the practitioners will focus on including exercises that include bending the fingers, opening and closing the hand and, eventually, slowly rotating the wrist. Also, assisted stretches are also used to increase flexibility.Since the patient may still have stiches, therapeutic stretches are performed in a gentle manner without the intention of reaching the end range of motion.
Other modalities like paraffin wax and whirlpool therapy using extremity pools can be used along with ultrasound therapy and electrical stimulation to help push fluids away from the affected area and improve function as well as decrease pain.
What most patients don’t realize is they can begin post-surgical carpal tunnel therapy within a few days after surgery. Even though the arm may still be wrapped in a soft cast, treatment can be modified to begin the strengthening process to help restore function to the wrist and hand. For most patients, it is necessary to have rehab sessions two or three times a week for about four to six weeks.
In addition to the use of cold compression therapy to address acute post-surgical pain, assisted stretching and strength-building exercises are the focus of Phase Two and will remain throughout the course of rehab. A great tool to use is the Theraband Hand Exerciser which is available in varying resistance levels to allow for graduated training as a patient’s strength increases.
Also, in this phase of therapy, post-treatment pain may be triggered. In addition to the continued use of paraffin wax and whirlpool therapy, the following modalities are beneficial to help reduce pain and improve function:
- Ultrasound therapy: Ultrasound
therapy is a great way to reduce post-surgical carpal tunnel patient’s pain.
Plus Ultrasound machine is
the perfect choice for practitioners because it comes with the choice of 1cm or
5 cm soundhead applicators which provide targeted treatment to areas like the
wrist. In addition, with the ability to program treatment to 3 MHz, treatment
is absorbed more rapidly, and is appropriate to treat the superficial tissues
like the carpal area.
- Electrical Stimulation: Electrical stimulation in the form of transcutaneous electrical nerve stimulation (TENS) can also reduce pain. Whether used as part of treatment or advised for home use with a portable unit, TENS can greatly reduce pain efficiently.
***Keep in mind, ultrasound therapy and electrical stimulation can be used alone or simultaneously with a combination unit to maximize treatment time and provide patients with immediate pain relief and improvement in function.***
Phase three-ADVANCED CARPAL TUNNEL SURGERY REHAB
At this point in the rehabilitation process, there is more focus on exercises that can strengthen the hand as well as stabilize muscles and joints. In addition to using therapy balls, practitioners may also utilize resistance bands with exercises like wrist curls to help improve strength without the undue stress on the wrist that free weights or machines may cause.
Also, working on motor control will be included to help prepare patients to return to work and other day to day activities. For fine motor control, tools like a motor skills coordination manipulation work bench are a great choice to help improve strength and endurance of the wrists and hands as well as fine motor coordination. This type of device allows patients to work bilaterally to help improve functionality amongst both sides.
Unfortunately, certain occupational and recreational activities can sometimes cause or aggravate carpal tunnel syndrome even in post-surgical patients. It’s important for therapists to provide patients with education on a variety of techniques to avoid future problems involving the wrists. This may include providing a Home-Exercise Program (HEP) for patients to help maintain their progress after treatment concludes. These exercises may include tendon gliding movements as well as strengthening exercises using tools like a hand exerciser to improve finger, hand and wrist strength. The Handmaster Plus is one such hand exerciser tool that can be used by patients at home to continue strengthening their wrists post-surgery.
Contact Us Today
We can help find the right therapeutic device or equipment to help improve the strength and function in your post-surgical carpal tunnel syndrome patients. Contact us today and we’ll help you find exactly what you need to improve the long-term outcomes for your carpal tunnel patients. Call us today at 1-801-770-3328.